Virginia Tech Carilion School of Medicine student’s research leads to policy changes
March 14, 2017
Jessica Nguyen would have never pictured herself as a medical student a decade ago — let alone one receiving a letter of distinction for her research project.
“I was the first person in my family to get a college degree, so being a physician was never even on my radar. I assumed you had to be super brilliant or part of this special class of people,” Nguyen said.
She had two children early on in adulthood and then went to nursing school. Nguyen’s experience working in the emergency room as a scribe – essentially a note taker for physicians – changed her perspective.
“When I worked with doctors, I thought, I think I can do this. They are not any smarter than I am, they just have more education," she said.
Nguyen and her husband decided she would try applying to medical schools once. If she didn’t get in, she would pursue a career as a nurse practitioner.
Based on grades and test scores, Nguyen thought the Virginia Tech Carilion School of Medicine was a big reach for her. When the admissions team called and said she had been accepted, Nguyen double-checked that they had called the right person.
“Once coming here, I realized this school, even though they do bring people in who are very smart, they also place a very high value on life experience,” Nguyen said. “I think they are really good, even being so young as a medical school, at picking a diverse body of students that bring a lot to the table and richness to the school.”
After arriving, Nguyen again questioned her place at the college when it came to the research portion of the curriculum. Every student is required to complete a research project of publishable quality in order to graduate. Research is threaded throughout the four-year curriculum.
“I didn’t have research experience, and, in fact, it very much intimidated me,” Nguyen said.
Her fears were first eased by some helpful guidance from the team that oversees the research curriculum. Then, Nguyen found a topic she could relate to after meeting with Katie Love Bower, assistant professor of surgery at the Virginia Tech Carilion School of Medicine.
Hospitals had begun implementing policies to remove catheters as soon as possible because Medicare and Medicaid would not reimburse if the patient suffered a catheter-associated urinary tract infection (CAUTI).
Anecdotally, Bower had observed that some patients had other complications, possibly because catheters had come out too early.
“We know that the risk of infection increases with each day an indwelling catheter remains in place," Bower said. "In the interest of patient safety, our goal is to remove a catheter as soon as it is no longer clinically indicated. Prompted by financial penalty, policies, and education, initiatives to encourage earlier catheter removal have been enacted all over the country with the best of intentions, and seemed to have created some other problems for patients in the process.”
She wanted to see if her observations were valid.
The idea resonated with Nguyen; as she was leaving the nursing field, the policy at her hospital had become so strict that anyone who placed a catheter that later led to an infection was put on probation for six months, causing frustration among the nursing staff.
“Infection is a known risk of having a catheter placed, but there are very good reasons for why we do it. You don’t want to scare people from using them because they have their function,” Nguyen said. “It was a bit like the pendulum had swung too far the other way.”
Under the guidance of Bower, Nguyen looked at catheter use and complications at Carilion Roanoke Memorial Hospital from 2009 to 2013. Right in the middle of that period, in 2011, a policy was enacted that encouraged earlier removal of the indwelling catheter in favor of intermittent catheterization.
“We were able to compare complication rates before and after the policy was implemented,” Nguyen said.
Nguyen and Bower did not see a difference in infection rates during the two time periods, but they did find that patients were more likely to suffer other complications, such as higher urinary retention rates or a need to get a catheter replaced, after the policy change.
“Instead of focusing all of our energy on removing the catheter as soon as possible, maybe we should shift some of our focus onto what is the optimal time frame and optimal patient presentation to have the catheter removed,” Nguyen said.
In response to their findings, a protocol was developed with multidisciplinary input that included a list of “yes” or “no” questions aimed at finding the ideal time to remove a catheter for each individual patient.
“If they answered ‘no’ to any of those questions, then providers work to fix those things before removing the catheter,” Nguyen said. “Once the catheter is removed, there are some monitoring parameters that need to be done for a certain length of time to make sure they pass the trial without a catheter.”
Nguyen presented her findings at the Southeast Surgical Congress, and it was published nationally in American Surgeon. Her work directly impacted policies at Carilion Roanoke Memorial Hospital.
“For something that is as intimidating as research that your graduation hinges on, I thought research was going to be a constant source of agony for me, and then I ended up receiving a letter of distinction for it. I’ve gone from being relatively new to all of it to the point where I am really interested in research and want to continue doing it as a resident and physician,” Nguyen said. “I think this school does a really good job of fostering that desire to at least keep one foot in the research world rather than just becoming a doctor and not really ever furthering your field. That is unique to this program and not many other medical schools require it.”
Nguyen will pursue an emergency medicine residency after graduating in May.
Nguyen is one of eight students in this year’s graduating class of 40 who have been selected to present their work during the VTCSOM Medical Student Research Symposium on March 24.
The event is from noon to 5 p.m. in room 203 at the school. Admission is free, and the public is invited to attend.